ExecTech Client - Legal Questionnaire

  • ExecTech Client - Legal Questionnaire

  • The purpose of this checklist is to help you find and prevent legal problems before they can hurt you or your practice.

    While no list can cover every possible legal risk you face, this checklist includes most common legal problems experienced by practice owners.

    If you are currently involved in a legal action (lawsuit, government investigation, etc.), ExecTech should not get involved. However, if you do not have an attorney, or feel your attorney is not handling the situation as well as you like, we may be able to refer you to a more competent attorney.

    You can scroll to the bottom of the form and save your progress to continue later if you are not able to complete in one sitting.

  • General Questions

  • 1. Business Taxes. Are you concerned if you are properly paying your business taxes, sales taxes, payroll taxes or business property taxes?
  • 2. Taxes Audit Protection. Do you have a tax expert who will represent you in an audit?
  • 3. New Patient Arrangements. Do you have any questions or concerns about marketing activities that may be inappropriate?
  • 4. Office Safety. Do you have any questions or concerns regarding your OSHA requirements?
  • 5. Unprofessional Conduct. Do you have any questions or concerns regarding activities that might be construed as unprofessional conduct?
  • 6. HIPAA Privacy Rule. Do you have any questions or concerns regarding the HIPAA Privacy Rule?
  • 7. Pending Issues. Do you have any concerns regarding the competency of your legal counsel?
  • 8. Drugs. Do you have any questions or concerns regarding the handling, dispensing or prescribing of drugs by your practice?
  • 9. Advertising. Do you have any questions or concerns regarding the laws for advertising?
  • 10. Contracts. Do you have any questions or concerns regarding a contract you have signed or should have signed?
  • 11. Partnership Agreement. Are you in a partnership arrangement without a written agreement?

  • Patient Care

  • 12. Malpractice Insurance. Do you have any questions or concerns regarding your professional liability insurance coverage?
  • 13. Malpractice Insurance Restrictions. Do you have any questions or concerns regarding your policy, such as what you can or cannot do?
  • 14. Associate/Partner Malpractice Insurance. Do you have any questions or concerns regarding malpractice protection for your associate’s or partner’s acts?
  • 15. Former Associate/Partner Malpractice Insurance. Do you have any questions or concerns regarding a leaving or former associate’s or partner’s coverage?
  • 17. If you have informed consent forms, has your malpractice insurance carrier approved the wording?
  • 18. Informed Refusal. Do you have any questions or concerns regarding a patient who refuses to follow your recommendations?
  • 19. If you have informed refusal forms, has your malpractice insurance carrier approved the wording?
  • 20. Documentation. Do you have any questions, weaknesses or concerns regarding your office’s proper documentation of each patient’s care?
  • 21. Files. Are your patient records in excellent condition?
  • 22. Sexual Harassment. Do you have any concerns or questions about patient sexual harassment?
  • 23. Patient Dismissal. Do you know how to dismiss patients in a safe and legal manner?
  • 24. Patient Complaints. Do you have any questions or concerns regarding current or former patients who may possibly be unhappy with your treatment?
  • 25. Complaint System. Do you have any questions, weaknesses or concerns regarding a system to catch and resolve patient complaints before they escalate?
  • 26. Emergencies. Do you have any questions regarding patient emergencies that can arise during treatment in your practice?

  • Fees and Collections

  • 27. Fees. Do you have any questions or concerns about the law regarding fees?
  • 28. Fee Arrangements. Do you have any questions or concerns about fee splitting or fee fixing?
  • 29. Third-party Collections. Do you have any concerns about the legalities of collecting from third-party payers?
  • 30. Patient Collections. Any questions or concerns regarding the legalities for collecting from patients?
  • 31. Insurance Fraud. Any questions or concerns about coding, billing, fraud and so on?
  • 32. Insurance Company Conflicts. Do you have any questions or concerns that you might become involved in a legal conflict with an insurance company?
  • 33. Advance Pay Packages. Do you discount your fees for patients who pay for packages of care in advance?
  • 34. If you offer such discounts, do you have patients sign an Advance Pay Agreement?
  • 35. Hardship Patients. When you give discounts to hardship patients, do you have them sign an agreement?

  • Labor Law

  • 36. Job Application. Does your job application cover your legal bases? (Click the yellow questionnaire mark for details.)
  • 37. Employment Agreement. Do you have a written agreement with all your employees?
  • 38. Associate Agreement. Do you have a written associate agreement with your associate doctor(s)?
  • 39. Sub-contractors or Independent Contractors (same thing). Does anyone work for you on a sub-contractor arrangement?
  • 40. If so, do you have a written sub-contract agreement with this person or persons?
  • 41. Office Policy/Employee Manual/Staff Handbook (same things). Do you have a written office policy/employee manual/staff handbook?
  • 42. If you have an office policy or staff handbook, has a labor attorney written or reviewed it?
  • 43. If you have a policy or handbook, have all your staff members signed agreements that they have received and understand the policy?
  • 44. Exempt Employees. Do you classify any of your staff members as exempt employees and pay them a salary without overtime pay?
  • 45. Overtime Pay. Do you have any questions or concerns regarding overtime pay?
  • 46. Workers' Compensation Insurance. Do you have any questions or concerns regarding your work comp insurance coverage for your employees?
  • 47. Personnel Files. Do you keep a complete employment file on each employee
  • 47. Personnel Files. Do you keep a complete employment file on each employee
  • 48. Staff Complaints. Do you have a system in place to catch and resolve staff member complaints before they escalate into legal matters?
  • 49. Staff Relations. Do you have any questions or concerns regarding any of your current or past employees who might file a complaint or claim against you?
  • 50. Licensing. Do you have any questions or concerns regarding the delegation of technical duties to staff?

  • Personal Issues

  • 51. Past Connections. Are you concerned anyone from your past might want to hurt you or your practice (i.e., ex-spouse, former partner, former employee)?
  • 52. Asset Protection. Do you have any questions or concerns regarding your legal asset protection plan or do you need such a plan?
  • 53. Last Will and Testament. Do you have a current will?
  • 54. Living Will. Do you have a living will?
  • 55. Estate Plan. Do you have an estate plan?
  • 56. Insurance. Do you have adequate life and disability insurance?
  • 57. Death and Disability Practice Plan: Do you have a written plan for your practice should you die or become incapacitated?
  • 58. Final. Do you have any legal questions or concerns not covered by this questionnaire?

  • Thank you! Please submit.

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